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Association between persistent psychological distress and 12 year cardiovascular and total mortality in patients with stable coronary artery disease

Session Best Posters session 5

Speaker Ralph Stewart

Event : ESC Congress 2015

  • Topic : preventive cardiology
  • Sub-topic : Stress, Psycho-Social and Cultural Aspects of Heart Disease
  • Session type : Best ePosters

Authors : R A H Stewart (Auckland,NZ), D M Colquhoun (Brisbane,AU), S L Marshner (Sydney,AU), J Simes (Sydney,AU), A C Kirby (Sydney,AU), P J Nestel (Melbourne,AU), N Glozier (Sydney,AU), A O'neil (Melbourne,AU), A M Tonkin (Melbourne,AU), H D White (Auckland,NZ)

Authors:
R.A.H. Stewart1 , D.M. Colquhoun2 , S.L. Marshner3 , J. Simes3 , A.C. Kirby3 , P.J. Nestel4 , N. Glozier5 , A. O'Neil6 , A.M. Tonkin7 , H.D. White1 , 1Green Lane Cardiovascular Service, Auckland City Hospital - Auckland - New Zealand , 2Greenslopes Hospital - Brisbane - Australia , 3University of Sydney, National Health and Medical Research Council Clinical Trials Centre - Sydney - Australia , 4Baker IDI Heart and Diabetes Institute - Melbourne - Australia , 5University of Sydney, Sydney Medical School - Sydney - Australia , 6University of Melbourne, Melbourne School of Population & Global Health, Non Communicable Disease Unit - Melbourne - Australia , 7Monash University, Department of Epidemiology and Preventive Medicine - Melbourne - Australia ,

On behalf: LIPID Study Investigators

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 725

Background: Psychological distress has been associated with higher mortality, but the importance of persistence of symptoms over time is not known.

Aim: To determine whether persistent or intermittent psychological distress is associated with cardiovascular and total mortality in patients with stable coronary artery disease.

Methods: 940 participants enrolled in the Long Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial completed ≥4 General Health Questionnaires (GHQ-30) at baseline and after 6 months, 1, 2 and 4 years. The hazard ratio (HR) for cardiovascular (CV) and total mortality were determined after follow-up for the next 12.1, (IQR 8.6,12.5) years for subjects who reported mild (GHQ score >5) and more severe (GHQ score >10) psychological distress which was either intermittent (on one or two occasions), or persistent (on 3 or more occasions) compared with those reporting no distress. HR's were adjusted for baseline variables.

Results: Moderate to severe psychological stress was reported >60% of the time by 35 (4%) subjects. These patients had higher CV (adjusted HR 2.50, 95% CI 1.44 to 4.36, p=0.0012), and all-cause mortality (adjusted HR 2.02, 95% CI 1.32 to 3.14, p=0.0013). In contrast, 168 (18%) patients who reported moderate-severe distress once or twice did not have higher CV (adjusted HR 0.93, 95% CI 0.64 to 1.34, p=0.69) or all-cause mortality (adjusted HR 0.94, 95% CI 0.73 to 1.22, p=0.65). The associations between less severe psychological distress (GHQ>5) present >60% of the time and CV (adjusted HR 1.17, 95% CI 0.76 to 1.82, p=0.47) and total mortality (HR 1.30, 95% CI 0.96 to 1.76, p=0.08) were not statistically significant, and there was no association with mortality if present <50% of the time.

Conclusion: In patients with stable coronary artery disease, persistent moderate-severe psychological distress was associated with a substantially higher risk of long-term cardiovasucular and total mortality, but distress that was not persistent was not associated with mortality. Further research is needed to determine whether reducing persistent psychological distress improves outcomes in this high risk group.

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